Look up the most recent NPI and PECOS records

Phillip Johnson

Psychologist

Behavioral Health & Social Service Providers

1500 E. Woodrow Wilson Ave., Jackson, MS 39216-5116

PECOS Enrollment

Based on the most recent information from CMS, provider Phillip Johnson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1457824849
Provider Type
Individual
Full Name
Johnson, Phillip
Title
Dr.
Credential
PSY.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
1/8/2019
Last Updated
6/14/2023

Contact Information

Practice Location

1500 E. Woodrow Wilson Ave., Jackson, MS 39216-5116

(601) 362-4471

Unlisted Fax

Mailing Location

1500 E. Woodrow Wilson Ave., Jackson, MS 39216-5116

(601) 362-4471

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License 631163 Mississippi
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer
Code 103T00000X	Description Psychologist Behavioral Health & Social Service Providers	License Unlisted Issuer

Phillip Johnson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Logan, Patricia

Lott, William C

Crane, Kristi Leann

Burgess, Danny Ray

Greening, Leilani Lani

Young, Lashun A.

Dees, Jesse F

Smith, Patrick O

Sutton, Monica J

Voluse, Andrew Craig